Mitchell Besser: Mothers helping mothers fight HIV

18,380 views ・ 2010-09-23

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翻译人员: yifan xie 校对人员: XIN ZHENG
00:16
I want you to take a trip with me.
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我要你们和我一起去体验一段旅程.
00:18
Picture yourself driving
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想象你们开着车
00:20
down a small road in Africa,
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行驶在非洲的一条小路上,
00:22
and as you drive along, you look off to the side,
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行驶途中, 当你透过车窗,望向路旁,
00:25
and this is what you see:
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这是你所看到的景象:
00:27
you see a field of graves.
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你看到一片坟墓.
00:29
And you stop, and you get out of your car and you take a picture.
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你停下来,走下车,将这一幕拍下.
00:31
And you go into the town,
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然后你到了镇里,
00:33
and you inquire, "What's going on here?"
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问人们, "照片上这个地方发生了什么事情?"
00:35
and people are initially reluctant to tell you.
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大家一开始不愿意告诉你.
00:37
And then someone says,
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然后有人说,
00:39
"These are the recent AIDS deaths in our community."
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"这些是最近在我们这里因为艾滋病而死的人."
00:43
HIV isn't like other medical conditions;
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艾滋病不像别的病;
00:45
it's stigmatizing.
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它让人觉得羞耻自卑.
00:47
People are reluctant to talk about it --
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人们不愿意谈及它.
00:50
there's a fear associated with it.
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它让人感到恐惧.
00:52
And I'm going to talk about HIV today,
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而我今天将会谈及艾滋病,
00:54
about the deaths,
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谈及由它引起的死亡,
00:56
about the stigma.
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以及人们关于对艾滋病的这种羞耻心理.
00:58
It's a medical story, but more than that, it's a social story.
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这不仅是一个医学上的问题, 也是一个社会问题.
01:03
This map depicts the global distribution of HIV.
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这幅地图描绘了全球艾滋病的分布情况.
01:06
And as you can see,
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同时, 你们可以看见,
01:08
Africa has a disproportionate share of the infection.
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非洲受感染比例大大超出平均水平.
01:10
There are 33 million people
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今天全球有3300万
01:12
living with HIV in the world today.
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艾滋病带菌者.
01:14
Of these, two-thirds, 22 million
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其中,三分之二, 也即2200万,
01:17
are living in sub-Saharan Africa.
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生活在撒哈拉以南非洲.
01:20
There are 1.4 million pregnant women
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有140万怀孕的女性
01:23
in low- and middle-income countries living with HIV
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带着艾滋病病毒生活在中低收入国家,
01:26
and of these, 90 percent
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而其中的90%
01:28
are in sub-Saharan Africa.
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就在撒哈拉以南的非洲.
01:32
We talk about things in relative terms.
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让我们通过对比来说明问题.
01:34
And I'm going to talk about annual pregnancies
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以每年怀孕
01:36
and HIV-positive mothers.
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的带有艾滋病病毒的母亲为例.
01:38
The United States -- a large country --
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在美国 -- 一个大国 --
01:40
each year, 7,000 mothers with HIV
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每年有七千带有艾滋病病毒的母亲
01:43
who give birth to a child.
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生下孩子.
01:46
But you go to Rwanda -- a very small country --
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但在卢旺达 -- 一个很小的国家 --
01:49
8,000 mothers with HIV who are pregnant.
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每年就有8千个带有艾滋病病毒的母亲怀孕.
01:53
And then you go to Baragwanath Hospital,
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Baragwanath医院,
01:56
outside of Johannesburg in South Africa,
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位于南非约翰内斯堡的远郊,
01:59
and 8,000 HIV-positive pregnant women
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那儿每年有八千个携有艾滋病病毒的母亲
02:01
giving birth --
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临产 --
02:03
a hospital the same as a country.
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一个医院就抵过一个国家.
02:06
And to realize that this is just the tip of an iceberg
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想一想这只是冰山一角,
02:09
that when you compare
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因此, 当你拿这里所发生的一切
02:11
everything here to South Africa, it just pales,
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与南非相比, 都显得不值一提,
02:13
because in South Africa,
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因为,在南非,
02:16
each year 300,000 mothers with HIV
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每年就有30万携带艾滋病病毒的母亲
02:19
give birth to children.
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临产.
02:23
So we talk about PMTCT,
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当我们谈到PMTCT,
02:25
and we refer to PMTCT, prevention of mother to child transmission.
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我们所说的PMTCT, 即防止母子垂直传染.
02:28
I think there's an assumption amongst most people in the public
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我想大部分公众会认为
02:31
that if a mother is HIV-positive,
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如果一个母亲是艾滋病带菌者,
02:33
she's going to infect her child.
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那么, 她就会把这个病毒传染给她的孩子.
02:35
The reality is really, very different.
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这与事实却相去甚远.
02:38
In resource-rich countries,
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在资源富足的国家,
02:40
with all the tests and treatment we currently have,
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在我们现有的检测和治疗条件下,
02:42
less than two percent of babies are born HIV-positive --
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仅有不到2%的婴儿生下来后艾滋病病毒检测是呈阳性.
02:45
98 percent of babies are born HIV-negative.
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98%的婴儿在生下来的时候艾滋病病毒检测是阴性.
02:49
And yet, the reality in resource-poor countries,
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但是, 现实是在资源稀缺的国家,
02:51
in the absence of tests and treatment,
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在缺乏检测和治疗条件下,
02:53
40 percent -- 40 percent of children are infected --
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40%, 40% 的孩子生下来就被感染了艾滋病病毒 --
02:56
40 percent versus two percent --
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40% 比 2% --
02:58
an enormous difference.
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是相当大的差距.
03:00
So these programs --
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而这些项目--
03:02
and I'm going to refer to PMTCT though my talk --
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我将在我的讲话里称之为PMTCT --
03:04
these prevention programs,
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这些预防项目,
03:06
simply, they're the tests and the drugs that we give to mothers
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简单的说, 是指为母亲们提供检测和药物
03:09
to prevent them from infecting their babies,
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来防止她们将病毒传染给她们的孩子,
03:12
and also the medicines we give to mothers
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同时, 我们也为母亲们提供药品
03:14
to keep them healthy and alive to raise their children.
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以便她们能够健康地活着并带大她们的孩子.
03:16
So it's the test a mother gets when she comes in.
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所以, 母亲们来到这里时会接受这样一个检测,
03:18
It's the drugs she receives
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这是给她的药品
03:20
to protect the baby that's inside the uterus and during delivery.
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用来保护婴儿在子宫里和生产过程中不受感染
03:23
It's the guidance she gets around infant feeding
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这是她所接受的关于哺乳
03:25
and safer sex.
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和性生活的辅导
03:27
It's an entire package of services,
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这是这一整套的服务,
03:30
and it works.
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而它是行而有效的.
03:32
So in the United States,
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所以在美国,
03:34
since the advent of treatment in the middle of the 1990s,
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自从上个世纪90年代中在艾滋病治疗上取得进步以后,
03:37
there's been an 80-percent decline
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就实现了80%的减幅,
03:39
in the number of HIV-infected children.
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在艾滋病带菌儿童的数目上.
03:41
Less than 100 babies are born with HIV
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仅有不到100个婴儿是生下来就带着艾滋病病毒的,
03:43
each year in the United States
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每年, 在美国.
03:45
and yet, still,
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但是, 目前
03:47
over 400,000 children
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每年全球仍然有超过40万儿童
03:50
are born every year in the world today with HIV.
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生下来就是艾滋病带菌者.
03:54
What does that mean?
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这意味着什么呢?
03:56
It means 1,100 children infected each day --
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这意味着每天有1,100个儿童受感染 --
03:59
1,100 children each day, infected with HIV.
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每天1,100个儿童感染艾滋病病毒.
04:02
And where do they come from?
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他们来自哪里呢?
04:04
Well, less than one comes from the United States.
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这个, 来自美国的少于一个.
04:08
One, on average, comes from Europe.
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平均来自欧洲的有一个.
04:12
100 come from Asia and the Pacific.
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100个来自亚太地区.
04:16
And each day,
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而每天,
04:18
a thousand babies -- a thousand babies
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就有一千个携带艾滋病病毒的婴儿, 一千个,
04:21
are born each day with HIV in Africa.
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在非洲出生.
04:26
So again, I look at the globe here
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因此, 当我再看看这张全球分布图
04:28
and the disproportionate share of HIV in Africa.
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能看到, 非洲在艾滋病带菌者分布上的高比例.
04:31
And let's look at another map.
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让我们来看另外一幅地图.
04:33
And here, again, we see
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在这里我们再次看到
04:35
Africa has a disproportionate share of the numbers of doctors.
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非洲的医生数量远远低于平均水平.
04:38
That thin sliver you see here, that's Africa.
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那薄薄的银色部分, 就是非洲了.
04:41
And it's the same with nurses.
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护士的数量也一样.
04:44
The truth is sub-Saharan Africa
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事实是, 在撒哈拉以南非洲
04:46
has 24 percent
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占了全球24%
04:48
of the global disease burden
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的疾病分布
04:50
and yet only three percent of the world's health care workers.
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但是,却仅有3%的医护人员在这里工作.
04:53
That means doctors and nurses
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这意味着医生和护士
04:55
simply don't have the time to take care of patients.
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根本就没有时间去照顾病人.
04:58
A nurse in a busy clinic
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在一个繁忙的诊所里, 一个护士
05:00
will see 50 to 100 patients in a day,
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每天要看50 到100 个病人,
05:02
which leaves her just minutes per patient --
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在每个病人身上她只能花几分钟 --
05:04
minutes per patient.
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几分钟.
05:06
And so when we look at these PMTCT programs, what does it mean?
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所以, 当我们重新谈及PMTCT项目的时候, 这意味着什么呢?
05:09
Well, back in 2001,
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在2001年的时候,
05:11
when there was just a simple test
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那个时候只有一个简单的测试
05:13
and a single dose of a drug,
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和一剂药
05:15
a nurse, in the course of her few minutes with a patient,
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每个护士, 在跟一个病人相处的短短的几分钟里,
05:18
would have to counsel for the HIV test, perform the HIV test,
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她要对这个病人做艾滋病病毒检测,
05:21
explain the results, dispense a single dose of the drug, Nevirapine,
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解释检测结果, 配一剂药- Nevirapine,
05:24
explain how to take it, discuss infant feeding options, reinforce infant feeding,
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向病人说明如何用药, 跟她讨论如何更好地哺育婴儿,,
05:27
and test the baby -- in minutes.
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还要在这几分钟里对婴儿进行检测.
05:30
Well, fortunately since 2001,
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幸好, 从2001年以后,
05:32
we've got new treatments, new tests,
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我们有了新的治疗方法, 新的检测手段,
05:34
and we're far more successful,
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我们的工作取得了很大的进步,
05:36
but we don't have any more nurses.
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但我们没有更多的护士.
05:38
And so these are the tests
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而这些测试是
05:41
a nurse now has to do
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一个护士必须完成的
05:43
in those same few minutes.
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在同样的短短几分钟里.
05:45
It's not possible --
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这样不行.
05:47
it doesn't work.
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这是没有效果的.
05:49
And so we need to find
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我们必须想出
05:51
better ways of providing care.
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更好的方法来护理这些病人.
05:56
This is a picture of a maternal health clinic in Africa --
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这个图显示了非洲的产妇健康诊所--
05:59
mothers coming, pregnant and with their babies.
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母亲们怀着她们的婴儿来到这些诊所.
06:02
These women are here for care,
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这些女人是来接受医疗护理的,
06:04
but we know that just doing a test,
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但是我们知道, 只做一个检测,
06:06
just giving someone a drug,
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只给她们一份药,
06:08
it's not enough.
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是不够的.
06:11
Meds don't equal medical care.
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药品并不等于医疗护理.
06:14
Doctors and nurses, frankly,
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坦白说, 医生和护士,
06:16
don't have the time or skills
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没有足够的时间和技巧
06:18
to tell people what to do in ways they understand.
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用人们能够明白的途径来告诉他们该怎么做.
06:20
I'm a doctor -- I tell people things to do,
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我是一个医生. 我告诉人们该做的事,
06:23
and I expect them to follow my guidance --
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而我也期待他们根据我的指引去做 --
06:25
because I'm a doctor; I went to Harvard --
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因为我是一个医生, 我在哈佛读过书 --
06:27
but the reality is,
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但实际上,
06:29
if I tell a patient, "You should have safer sex.
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如果我跟一个病人说, "你应该有更安全的性生活.
06:31
You should always use a condom,"
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你应该一直使用避孕套,"
06:33
and yet, in her relationship, she's not empowered --
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这不起作用, 因为在她和异性的关系里, 她并没有这种权力 --
06:36
what's going to happen?
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那接下来会发生什么呢?
06:38
If I tell her to take her medicines every day
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如果我让她每天吃药,
06:41
and yet, no one in the household knows about her illness, so
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但是, 她的家里没有人知道她的病, 那
06:44
it's just not going to work.
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这根本就不会起作用.
06:47
And so we need to do more,
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所以我们必须做更多,
06:49
we need to do it differently,
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我们必须采用不同的途径,
06:51
we need to do it in ways that are affordable
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我们必须通过更实际的
06:54
and accessible and can be taken to scale,
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更可行的的和更容易被推广的方式来做这些事情,
06:56
which means it can be done everywhere.
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这意味着它在什么地方都能使用.
06:59
So, I want to tell you a story --
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所以,我要告诉你们一个故事.
07:02
I want to take you on a little trip.
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我要带你们经历一段短暂的旅程
07:04
Imagine yourself, if you can,
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如果可以的话,你想象一下,
07:06
you're a young woman in Africa, you're going to the hospital or clinic.
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你是一个年轻的非洲女性, 你要去一个医院或诊所.
07:09
You go in for a test
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你去做一个检测,
07:11
and you find out that you're pregnant, and you're delighted.
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然后, 你发现你怀孕了, 你很兴奋.
07:13
And then they give you another test
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但他们又让你做了另外一个测试,
07:15
and they tell you you're HIV-positive, and you're devastated.
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然后告诉你, 你对艾滋病病毒呈阳性反应, 你绝望了.
07:18
And the nurse takes you into a room,
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护士把你带到一个房间里,
07:20
and she tells you about the tests
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她跟你解释这些检测的项目,
07:22
and HIV and the medicines you can take
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解释什么是艾滋病,并告诉你该吃什么药,
07:24
and how to take care of yourself and your baby,
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怎么来照顾你自己和你的孩子,
07:26
and you hear none of it.
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但是你什么都听不进去.
07:28
All you're hearing is, "I'm going to die,
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你能听见的是, "我要死了,
07:30
and my baby is going to die."
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我的宝宝也要死了."
07:32
And then you're out on the street, and you don't know where to go.
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然后你走到街上, 你不知道要去什么地方,
07:34
And you don't know who you can talk to,
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你也不知道能跟谁倾诉,
07:36
because the truth is, HIV is so stigmatizing
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因为现实是,艾滋病是那么让人忌违
07:39
that if you partner, your family, anyone in your home,
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你的另一半,你的家人,家里任何一个人, 如果知道这件事的话,
07:42
you're likely to be thrown out
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你就很有可能会被赶出去
07:44
without any means of support.
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无依无靠.
07:46
And this -- this is the face and story
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而这个, 这个就是
07:48
of HIV in Africa today.
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今天艾滋病病人在非洲的处境, 以及她们的故事.
07:51
But we're here to talk about possible solutions
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但我们接下来还要谈可能的解决方案
07:54
and some good news.
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以及一些好消息.
07:56
And I want to change the story a little bit.
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而我要把这个故事稍稍改动一下.
07:59
Take the same mother, and the nurse, after she gives her her test,
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还是那个母亲, 还是那个护士。护士在给那个母亲做完检测以后,
08:02
takes her to a room.
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把她带到一个房间.
08:04
The door opens and there's a room full of mothers, mothers with babies,
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房间的门打开, 房间里都是母亲,带着婴儿的母亲,
08:07
and they're sitting, and they're talking, they're listening.
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她们坐在那里,谈话和聆听.
08:09
They're drinking tea, they're having sandwiches.
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她们在喝茶,她们在吃三文治.
08:12
And she goes inside, and woman comes up to her and says,
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她走进去, 女人们都过来跟她说,
08:14
"Welcome to mothers2mothers.
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"欢迎来到 mothers2mothers.
08:16
Have a seat. You're safe here.
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请坐下来. 你在这里很安全.
08:19
We're all HIV-positive.
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我们都是艾滋病带菌者.
08:21
You're going to be okay. You're going to live.
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你不会有事的, 你会生存下去.
08:24
Your baby is going to be HIV-negative."
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你的宝宝不会成为艾滋病带菌者."
08:29
We view mothers
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在我们的眼中,母亲们
08:31
as a community's single greatest resource.
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是这里最宝贵的资源.
08:33
Mothers take care of the children, take care of the home.
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她们照顾孩子,照顾家.
08:36
So often the men are gone.
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经常,男人们出去了.
08:38
They're working, or they're not part of the household.
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他们在外面工作, 或者并不跟孩子的母亲住在一起.
08:41
Our organization, mothers2mothers,
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我们的组织, mothers2mothers,
08:43
enlists women with HIV
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招募带有艾滋病病毒的女性
08:45
as care providers.
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来这里护理其他人。
08:47
We bring mothers who have HIV,
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我们让那些带有艾滋病病毒的母亲,
08:49
who've been through these PMTCT programs
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她们已经通过PMTCT项目
08:51
in the very facilities,
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特定疗程的治疗,
08:53
to come back and work side by side with doctors and nurses
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让她们回来和医生护士并肩工作
08:56
as part of the health care team.
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成为医疗护理队伍的一分子.
08:58
These mothers, we call them mentor mothers,
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这些母亲们,我们称她们为母亲指导员,
09:01
are able to engage women
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她们能够帮助那些
09:03
who, just like themselves, pregnant with babies,
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就像她们自己一样, 怀着孩子,
09:05
have found out about being HIV-positive,
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但又被发现是艾滋病带菌者,
09:07
who need support and education.
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需要支持和相关知识辅导的母亲.
09:10
And they support them around the diagnosis
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在诊疗的过程中, 她们提供的支持还包括:
09:12
and educate them about how to take their medicines,
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教她们怎样用药,
09:14
how to take care of themselves,
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如何照顾她们自己,
09:16
how to take care of their babies.
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如何照顾她们的孩子.
09:19
Consider: if you needed surgery,
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试想一下: 如果你需要手术,
09:22
you would want the best possible technical surgeon, right?
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你会要技术最好的外科医生来帮你做手术, 对吧.
09:26
But if you wanted to understand
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但是如果你想搞清楚
09:28
what that surgery would do to your life,
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这个手术会对你的生活带来怎样的影响,
09:30
you'd like to engage someone,
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你该会希望能够与那些
09:32
someone who's had the procedure.
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做过这个手术的人沟通。
09:34
Patients are experts on their own experience,
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久病成医,
09:37
and they can share that experience with others.
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病人之间可以分享自己的经验.
09:41
This is the medical care that goes beyond just medicines.
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这是仅仅靠吃药无法达到的医疗护理.
09:45
So the mothers who work for us,
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所以这些为我们工作的母亲,
09:47
they come from the communities in which they work.
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她们来自于她们工作所在的地区.
09:49
They're hired -- they're paid as professional members of the health care teams,
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她们受雇成为职业医疗护理队伍的一员,
09:52
just like doctors and nurses.
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就像医生和护士一样.
09:54
And we open bank accounts for them
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我们为她们开了银行帐户,
09:56
and they're paid directly into the accounts,
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她们的薪水是直接存到她们的帐户里,
09:58
because their money's protected;
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这样她们的钱就是安全的;
10:00
the men can't take it away from them.
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男人们不能把这些钱从她们身上拿走.
10:03
They go through two to three weeks
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她们会接受两到三周的
10:05
of rigorous curriculum-based education, training.
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严格的课程式教育和训练.
10:08
Now, doctors and nurses -- they too get trained.
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现在, 医生和护士也会接受培训.
10:11
But so often, they only get trained once,
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但是经常, 他们只受到一次培训,
10:13
so they're not aware of new medicines,
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所以他们并不了解最新的医药,
10:15
new guidelines as they come out.
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和最新出来的医疗指导
10:17
Our mentor mothers get trained every single year
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我们的母亲指导员们每年都要接受培训
10:19
and retrained.
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和再培训.
10:21
And so doctors and nurses --
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所以医生和护士,
10:23
they look up to them as experts.
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他们把这些母亲指导员看成专家.
10:26
Imagine that: a woman, a former patient,
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想象一下: 一个女人, 之前是病人,
10:29
being able to educate her doctor for the first time
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现在却能够开始教她的医生
10:31
and educate the other patients
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还有其他病人 --
10:33
that she's taking care of.
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那些由她照顾的病人.
10:36
Our organization has three goals.
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我们的组织有三个目标.
10:38
The first, to prevent mother-to-child transmission.
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第一: 防止母子垂直传染.
10:42
The second: keep mothers healthy, keep mothers alive,
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第二: 保持母亲健康, 让她们生存下去.
10:45
keep the children alive --
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让孩子生存下去.
10:47
no more orphans.
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再也不让他们成为孤儿了.
10:49
And the third, and maybe the most grand,
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第三, 或许是最高的目标,
10:52
is to find ways to empower women,
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就是给这些女性予力量,
10:56
enable them to fight the stigma
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让她们克服羞耻感,
10:58
and to live positive and productive lives with HIV.
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积极向上、更好地活着, 即使她们是艾滋病患者.
11:02
So how do we do it?
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那我们怎样做到这些呢?
11:04
Well, maybe the most important engagement
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也许最重要的尝试就是,
11:06
is the one-to-one,
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一对一的沟通,
11:08
seeing patients one-to-one, educating them, supporting them,
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一对一的看望病人, 教他们, 支持她们,
11:11
explaining how they can take care of themselves.
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告诉她们如何去照顾自己.
11:14
We go beyond that;
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我们所做的还不仅限于此.
11:16
we try to bring in the husbands, the partners.
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我们尝试让丈夫们或者配偶们加入进来.
11:19
In Africa, it's very, very hard to engage men.
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在非洲, 我们很难说动男人, 让他们参与进来.
11:22
Men are not frequently part of pregnancy care.
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一般男人们都不是孕期护理的一分子.
11:26
But in Rwanda, in one country,
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但是在卢旺达, 就在这个国家,
11:28
they've got a policy
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他们制定了一个政策,
11:30
that a woman can't come for care
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即, 一个女人单凭自身是无法获得这里的医疗护理,
11:32
unless she brings the father of the baby with her --
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除非, 她将孩子的父亲也一并带来.
11:34
that's the rule.
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这是规定.
11:36
And so the father and the mother, together,
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因此, 孩子的父亲和母亲将一起,
11:38
go through the counseling and the testing.
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接受咨询辅导和疾病检测.
11:41
The father and the mother, together, they get the results.
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同样, 孩子的父亲和母亲将一起面对检测结果.
11:43
And this is so important in breaking through the stigma.
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这样做对于克服羞耻感是相当重要的一步.
11:47
Disclosure is so central to prevention.
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披露病情对疾病防预是很关键的环节.
11:50
How do you have safer sex, how do you use a condom regularly
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你如何能拥有更安全的性生活, 如何能有规律地使用避孕套?
11:53
if there hasn't been disclosure?
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如果没有披露病情的话.
11:55
Disclosure is so important to treatment,
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公开病情对治疗是如此的重要,
11:58
because again, people need the support of family members and friends
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因为, 同样的, 人们需要家人和朋友的支持
12:01
to take their medicines regularly.
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以帮助他们定期用药.
12:04
We also work in groups.
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我们也通过团队的方式来完成这些工作.
12:06
Now the groups, it's not like me lecturing,
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现在, 这些团队,并这不像我在讲课一样,
12:08
but what happens is women, they come together --
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而是, 女人们自己走到一起,
12:11
under the support and guidance of our mentor mothers --
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通过我们的母亲指导员的支持和引导
12:13
they come together, and they share their personal experiences.
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她们走到一起, 分享各自的经验.
12:16
And it's through the sharing
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正是通过这种交流,
12:18
that people get tactics of how to take care of themselves,
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人们学会如何照顾自己,
12:20
how to disclose how to take medicines.
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如何披露自己的病情, 如何用药.
12:24
And then there's the community outreach,
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还能在当地起到示范效应,
12:26
engaging women in their communities.
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鼓励当地的女性参与进来.
12:29
If we can change the way
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如果我们能够改变
12:31
households believe and think,
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每一户人家的所信和所想,
12:33
we can change the way communities believe and think.
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我们就能改变这个地区人们的所信和所想.
12:36
And if we can change enough communities,
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如果我们能够改变足够多的区域,
12:38
we can change national attitudes.
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我们就能改变整个国家的态度.
12:40
We can change national attitudes to women
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我们能够改变整个国家对女性的态度
12:42
and national attitudes to HIV.
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以及他们对艾滋病病毒的态度.
12:45
The hardest barrier really is around stigma reduction.
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其实最大的困难是减轻人们对艾滋病病毒的羞耻感.
12:47
We have the medicines, we have the tests,
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我们有药品, 我们有疾病检测。
12:49
but how do you reduce the stigma?
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但是我们如何减轻人们的羞耻感呢?
12:52
And it's important about disclosure.
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而这对病情能否披露又很重要.
12:54
So, a couple years ago, one of the mentor mothers came back,
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所以, 几年前, 有一个母亲指导员回来找我们,
12:56
and she told me a story.
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她跟我讲了一个故事.
12:58
She had been asked by one of the clients
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她的一个病人请求她
13:00
to go to the home of the client,
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到这个病人的家里,
13:02
because the client wanted to tell the mother and her brothers and sisters
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因为这个病人要告诉她的母亲,兄弟和姐妹
13:05
about her HIV status,
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她的艾滋病病情,
13:07
and she was afraid to go by herself.
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但她害怕一个人去.
13:09
And so the mentor mother went along with.
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所以这个母亲指导员就跟着去了.
13:11
And the patient walked into the house
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这病人走进屋子里
13:13
and said to her mother and siblings,
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跟她的母亲和兄弟姐妹说:
13:16
"I have something to tell you. I'm HIV-positive."
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"我想告诉你们一些事. 我是艾滋病带菌者."
13:19
And everybody was quiet.
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这时, 每个人都很安静.
13:21
And then her oldest brother stood up and said,
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随后, 她最大的哥哥站起来说:
13:23
"I too have something to tell you.
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"我也有些事要告诉你们.
13:25
I'm HIV-positive.
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我是艾滋病带菌者.
13:27
I've been afraid to tell everybody."
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我一直不敢告诉大家."
13:30
And then this older sister stood up and said,
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然后她的大姐站起来说,
13:32
"I too am living with the virus,
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"我也带着这种病毒,
13:35
and I've been ashamed."
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我一直觉得很羞耻."
13:37
And then her younger brother stood up and said,
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然后比她年轻一些的弟弟也站起来说,
13:40
"I'm also positive.
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"我也是呈阳性.
13:42
I thought you were going to throw me out of the family."
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我以为你们会把我赶出这个家."
13:44
And you see where this is going.
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你可以看出事情是如何发展的.
13:46
The last sister stood up and said, "I'm also positive.
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最后一个妹妹站起来说, "我也是呈阳性的.
13:48
I thought you were going to hate me."
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我以为你们都会讨厌我."
13:50
And there they were, all of them together for the first time
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就这样, 他们一家人终于
13:52
being able to share this experience for the first time
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能够一起分享经验,
13:55
and to support each other for the first time.
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也首次能够彼此互相支持.
13:58
(Video) Female Narrator: Women come to us,
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(视屏) 女声: 女人们来找我们,
14:00
and they are crying and scared.
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她们都在哭,很害怕。
14:03
I tell them my story,
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我告诉她们我的故事,
14:05
that I am HIV-positive,
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我是个艾滋病带菌者,
14:08
but my child is HIV-negative.
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但是我的孩子没有染上艾滋病病毒.
14:11
I tell them, "You are going to make it,
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我告诉她们, "你们都能够生存下去,
14:14
and you will raise a healthy baby."
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你们都会有一个健康的孩子."
14:18
I am proof that there is hope.
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我自己就是证明, 证明希望是存在的.
14:24
Mitchell Besser: Remember the images I showed you
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Mitchell Besser: 记住我给你们看的图像,
14:26
of how few doctors and nurses there are in Africa.
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在非洲, 那里的医生和护士是多么稀缺.
14:28
And it is a crisis in health care systems.
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这是一个当地医疗护理系统所存在的危机.
14:31
Even as we have more tests and more drugs,
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就算我们有更多的检测手段和药品,
14:33
we can't reach people; we don't have enough providers.
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我们也难以遍及这么多人; 我们没有足够的人手.
14:35
So we talk in terms of what we call task-shifting.
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所以, 我们提及所谓的任务转移.
14:37
Task-shifting is traditionally
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任务转移在传统上即
14:39
when you take health care services from one provider
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你在这个医疗服务提供者这里得到了
14:41
and have another provider do it.
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由另外一个人为你提供的医疗服务.
14:43
Typically, it's a doctor giving a job to a nurse.
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比如,一个医生将工作交给一个护士去完成.
14:45
And the issue in Africa
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但在非洲, 问题是
14:47
is that there are fewer nurses, really than doctors,
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那里的护士却比医生要少,
14:49
and so we need to find new paradigm for health care.
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所以我们要找到新的方式来提供医疗服务.
14:52
How do you build a better health care system?
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如何才能建立一个更好的医疗服务体系呢?
14:55
We've chosen to redefine the health care system
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我们选择将医疗服务体系重新界定为
14:57
as a doctor, a nurse and a mentor mother.
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由医生,护士和母亲指导员组合在一起的体系.
14:59
And so what nurses do
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护士们所做的
15:01
is that they ask the mentor mothers to explain
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就是安排母亲指导员, 去告诉病人
15:03
how to take the drugs, the side effects.
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如何用药,有什么副作用.
15:05
They delegate education about infant feeding,
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母亲指导员教病人喂养婴儿,
15:08
family planning, safer sex,
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做生育计划, 并实现安全的性生活,
15:10
actions that nurses simple just don't have time for.
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这些都是护士们没有时间去做的事.
15:15
So we go back to the prevention of mother to child transmission.
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现在我们回到防止母子传染这个话题上来.
15:18
The world is increasingly seeing these programs
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人们越来越倾向于将这些项目看作是
15:20
as the bridge to comprehensive maternal and child health.
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通向实现母子全面健康的桥梁.
15:23
And our organization
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我们的组织则
15:25
helps women across that bridge.
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帮助女性跨过这座桥梁.
15:27
The care doesn't stop when the baby's born --
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这些护理并不会因为婴儿的出生就停止.
15:29
we deal with the ongoing health of the mother and baby,
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我们继续关注母亲和婴儿的健康,
15:32
ensuring that they live healthy,
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让他们过上健康、
15:35
successful lives.
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美好的生活.
15:37
Our organization works on three levels.
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我们的组织在三个层面上工作.
15:40
The first, at the patient level --
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第一, 在病人层面上--
15:42
mothers and babies keeping babies from getting HIV,
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着眼于母亲和孩子, 保护孩子, 不让他们感染艾滋病病毒,
15:44
keeping mothers healthy to raise them.
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让母亲能够健康地养育他们.
15:47
The second, communities --
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第二, 社区层面 --
15:49
empowering women.
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鼓励女性, 给她们力量.
15:51
They become leaders within their communities.
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让她们成为所在地区团体的领导.
15:54
They change the way communities think --
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去改变当地人们的的看法.
15:56
we need to change attitudes to HIV.
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我们需要改变人们对艾滋病病毒的态度.
15:59
We need to change attitudes to women in Africa.
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我们需要改变非洲人们对女性的态度.
16:01
We have to do that.
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我们必须做到这点.
16:03
And then rework the level of the health care systems,
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然后重新运作医疗服务体系, 在这个层面,
16:06
building stronger health care systems.
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建立更健全的医疗保健系统.
16:08
Our health care systems are broken.
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我们的医疗服务体系存在诸多漏洞.
16:10
They're not going to work the way they're currently designed.
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以现有的架构, 他们是难以起到作用的.
16:13
And so doctors and nurses
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因此,当医生和护士们,
16:15
who need to try to change people's behaviors
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当他们没有技巧, 也没有时间去帮助人们
16:17
don't have the skills, don't have the time --
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改变相应行为时,
16:19
our mentor mothers do.
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我们的母亲指导员们能做到这些.
16:21
And so in redefining the health care teams by bringing the mentor mothers in,
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所以,通过将母亲指导员引入医疗服务体系,
16:24
we can do that.
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我们能做到这点.
16:27
I started the program in Capetown, South Africa
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我在南非开普敦开始了这个项目,
16:30
back in 2001.
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在2001年时,
16:32
It was at that point, just the spark of an idea.
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在那个时候, 这只是一个思想的火花.
16:35
Referencing Steven Johnson's very lovely speech yesterday
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想到Steven Johnson昨天所做的演讲
16:38
on where ideas come from,
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关于好主意的来源,
16:41
I was in the shower at the time --
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当这个思想火花闪现时,我正在洗澡.
16:44
I was alone.
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只有我一个人.
16:46
(Laughter)
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(笑声)
16:50
The program is now working in nine countries,
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这个项目现正在九个国家推广.
16:53
we have 670 program sites,
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我们有670个项目点.
16:56
we're seeing about 230,000
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我们每月接见大概23万
16:59
women every month,
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女性.
17:01
we're employing 1,600 mentor mothers,
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我们聘请1,600个母亲指导员.
17:04
and last year, they enrolled
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去年,她们共照看了
17:06
300,000 HIV-positive pregnant women and mothers.
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30万个带有艾滋病病毒的孕妇和母亲.
17:09
That is 20 percent
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这占到了全球20%的
17:12
of the global HIV-positive pregnant women --
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感染艾滋病病毒的怀孕妇女,
17:15
20 percent of the world.
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全世界的20%.
17:17
What's extraordinary is how simple the premise is.
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不可思议的是它的基本构思是多么的简单.
17:19
Mothers with HIV caring for mothers with HIV.
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用带有艾滋病毒的母亲来照顾带有艾滋病毒的母亲.
17:22
Past patients taking care of present patients.
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过去的病人来照顾现在的病人.
17:24
And empowerment through employment --
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和通过雇佣关系来给予他们权威和力量,
17:26
reducing stigma.
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减少忌讳和羞耻感.
17:28
(Video) Female Narrator: There is hope,
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(视屏)女声: 我们希望,
17:30
hope that one day
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希望有一天
17:32
we shall win this fight
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我们能赢得这场
17:34
against HIV and AIDS.
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对抗艾滋病病毒和艾滋病的战斗.
17:37
Each person must know
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每一个人都必须清楚
17:39
their HIV status.
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他们的艾滋病病毒感染情况.
17:42
Those who are HIV-negative
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那些不带有艾滋病菌的人
17:44
must know how to stay negative.
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必须知道怎样让自己不感染上艾滋病病毒.
17:48
Those who are HIV-infected
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那些受到艾滋病感染的人
17:51
must know how
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必须知道怎样
17:53
to take care of themselves.
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来照顾他们自己.
17:56
HIV-positive pregnant women
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带有艾滋病病毒的怀孕母亲
17:58
must get PMTCT services
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必须通过PMTCT治疗
18:01
in order to have
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以生出
18:03
HIV-negative babies.
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不带艾滋病病毒的婴儿.
18:05
All of this is possible,
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所有这些都是有可能的,
18:08
if we each contribute to this fight.
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如果我们每个人都投入这场战斗.
18:13
MB: Simple solutions to complex problems.
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MB: 用简单的方法来解决复杂的问题.
18:16
Mothers caring for mothers.
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母亲照顾母亲.
18:18
It's transformational.
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这将带来伟大的变革.
18:20
Thank you.
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谢谢你们.
18:22
(Applause)
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(鼓掌)
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